Ultrasound-Assisted Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

2018 ◽  
Vol 52 (3) ◽  
pp. 195-201 ◽  
Author(s):  
Prasoon P. Mohan ◽  
John J. Manov ◽  
Francisco Contreras ◽  
Michael E. Langston ◽  
Mehul H. Doshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Bleeding Risk ◽  
Right Heart ◽  
Systemic Thrombolysis ◽  
Catheter Directed Thrombolysis ◽  
Ultrasound Assisted ◽  
Vascular Obstruction ◽  
The Right ◽  
Pulmonary Vascular Obstruction

Purpose: Catheter-directed thrombolysis (CDT) is a relatively new therapy for pulmonary embolism that achieves the superior clot resolution compared to systemic thrombolysis while avoiding the high bleeding risk intrinsically associated with that therapy. In order to examine the efficacy and safety of CDT, we conducted a retrospective cohort study of patients undergoing ultrasound-assisted CDT at our institution. Methods: The charts of 30 consecutive patients who underwent CDT as a treatment of pulmonary embolism at our institution were reviewed. Risk factors for bleeding during thrombolysis were noted. Indicators of the right heart strain on computed tomography and echocardiogram, as well as the degree of pulmonary vascular obstruction, were recorded before and after CDT. Thirty-day mortality and occurrence of bleeding events were recorded. Results: Nine (30%) patients had 3 or more minor contraindications to thrombolysis and 14 (47%) had major surgery in the month prior to CDT. Right ventricular systolic pressure and vascular obstruction decreased significantly after CDT. There was a significant decrease in the proportion of patients with right ventricular dilation or hypokinesis. Decrease in pulmonary vascular obstruction was associated with nadir of fibrinogen level. No patients experienced major or moderate bleeding attributed to CDT. Conclusion: Catheter-directed thrombolysis is an effective therapy in rapidly alleviating the right heart strain that is associated with increased mortality and long-term morbidity in patients with pulmonary embolism with minimal bleeding risk. Catheter-directed thrombolysis is a safe alternative to systemic thrombolysis in patients with risk factors for bleeding such as prior surgery. Future studies should examine the safety of CDT in patients with contraindications to systemic thrombolysis.

scholarly journals Dead Space Ventilation Parallels Changes in Scintigraphic Vascular Obstruction at Recurrence of Pulmonary Embolism and after Thrombolytic Therapy: A Case Report

1998 ◽  
Vol 5 (3) ◽  
pp. 215-218 ◽  
Author(s):  
Marc A Rodger ◽  
Gwynne Jones ◽  
Francois Raymond ◽  
Daniel Lalonde ◽  
Mike Proulx ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Dead Space ◽  
Heparin Therapy ◽  
Alveolar Dead Space ◽  
Right Heart ◽  
Vascular Obstruction ◽  
Right Heart Dysfunction ◽  
Pulmonary Vascular Obstruction ◽  
Dead Space Ventilation

Physiological and alveolar dead space ventilation both increase in pulmonary embolism (PE) in proportion to the severity of vascular obstruction. The case of a patient with recurrent PE while on heparin therapy is presented. The recurrence was characterized clinically by severe pulmonary vascular obstruction and right heart dysfunction. The patient was treated with thrombolytic therapy, with excellent clinical and scintigraphic resolution. Dead space ventilation measurements at baseline, at the time of recurrence and after thrombolytic therapy are presented. The potential utility of dead space ventilation measurements for PE diagnosis and management are discussed.

scholarly journals Treatment Difficulties in High Risk Pulmonary Embolism. A Case Report

2016 ◽  
Vol 2 (1) ◽  
pp. 37-42
Author(s):  
Balázs Bajka ◽  
Edvin Benedek ◽  
Alexandra Stănescu ◽  
Emese Rapolti ◽  
Monica Chițu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Thrombolytic Agent ◽  
Bleeding Risk ◽  
Systemic Thrombolysis ◽  
Catheter Directed Thrombolysis ◽  
Increased Risk ◽  
Life Threatening ◽  
Surgical Embolectomy ◽  
High Bleeding Risk

Abstract Pulmonary embolism (PE) remains a common and potentially life-threatening cardiovascular emergency. Systemic thrombolysis with intravenous infusion of a thrombolytic agent is generally recommended for treatment of high risk PE. However, this method has known limitations in the presence of high bleeding risk. Catheter-directed thrombolysis has the potential to achieve the same benefits as systemic thrombolysis, with a lower risk of haemorrhage. The case presented is of a 67-year-old male patient with a high risk of pulmonary embolism and contraindications for systemic thrombolysis, in whom the presence of severe comorbidities presented an increased risk of surgical embolectomy, who was successfully treated by catheter-directed thrombolysis.

scholarly journals A case of successful systemic thrombolysis in massive thromboembolia of pulmonary artery against the background of pregnancy

2017 ◽  
Vol 21 (3) ◽  
pp. 95
Author(s):  
V. E. Tyukachev ◽  
D. A. Oks ◽  
A. A. Butylkin
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Thrombolytic Therapy ◽  
Conflict Of Interest ◽  
Main Pulmonary Artery ◽  
Interventricular Septum ◽  
Massive Pulmonary Embolism ◽  
Right Heart ◽  
Systemic Thrombolysis ◽  
The Right

<p>We present a clinical case of successful systemic thrombolysis in a pregnant patient with massive pulmonary embolism. A 29-year old patient at 28 weeks of pregnancy was hospitalized 2 hours after sudden suffocation in a presyncopal state and hypotension of 90/50 mm Hg. ECG showed the signs of overload of right heart chambers in the form of a typical S1-Q3-T3 (McGinn–White) syndrome, as well as the Kosuge sign. Echocardiography verified pulmonary 3 Grade hypertension (81 mm Hg), enlargement of the right atrium and ventricle, 3 Grade tricuspid regurgitation and paradoxical movement of the interventricular septum. Multislice computed tomography of the chest with contrast of the pulmonary artery revealed a defect of contrast in the right main pulmonary artery, occlusive clearance, and thrombotic mass, extending to the bifurcation of the left main pulmonary artery ("clot - rider"). Thrombolytic therapy was started with recombinant tissue plasminogen activator (alteplase 10 mg bolus, then 90 mg for 2 hours). The patient was daily examined by a gynecologist. The viability of the fetus, monitoring of possible hemorrhagic complications of the placenta were evaluated. After thrombolysis, the patient began to note clinical improvement in the form of a regression of dyspnea. According to echocardioscopy control, the signs of overload of right heart chambers completely regressed. There were no complications both in the mother and in the fetus during the subsequent days until discharge. On 25.05.16 there was uncomplicated delivery vaginally of live full-term girl. Thus, when there is life-threatening massive pulmonary embolism, the application of General principles of diagnosis and treatment of this disease in patients with pregnancy is warranted. The carrying out of thrombolytic therapy in massive pulmonary embolism enables to reduce the manifestations of pulmonary hypertension, right ventricular failure, and to conduct births on time. Used intravenous thrombolytics have no teratogenic effect in the later stages of pregnancy.</p><p>Received 18 April 2017. Accepted 5 June 2017.</p><p><strong>Funding:</strong> The study did not have sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p>

scholarly journals Pulmonary Embolism in COVID-19 Treated with VA-ECLS and Catheter tPA

2020 ◽  
Vol 14 ◽  
pp. 117954842095745
Author(s):  
Arda Akoluk ◽  
Usman Mazahir ◽  
Steven Douedi ◽  
Adel Aziz ◽  
Aref Obagi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Bleeding Risk ◽  
Massive Pulmonary Embolism ◽  
Response Monitoring ◽  
Circulatory Support ◽  
Systemic Thrombolysis ◽  
First Case ◽  
Catheter Directed Thrombolysis ◽  
Novel Coronavirus ◽  
Bail Out

Background: Novel coronavirus 2019 (COVID-19) has been the focus of the medical world since being declared a pandemic in March 2020. While the pathogenesis and heterogeneity of COVID-19 manifestations is still not fully understood, viral evasion of cellular immune responses and inflammatory dysregulation are believed to play essential roles in disease progression and severity. Case Presentation: We present the first case of a patient with COVID-19 with massive pulmonary embolism treated successfully with systemic thrombolysis, VA-ECLS, and bail out catheter directed thrombolysis. He was discharged from the hospital after an eventful hospital course on therapeutic anticoagulation with warfarin. Conclusions: We present the first case of a patient with COVID-19 with massive pulmonary embolism (PE) treated successfully with systemic thrombolysis, VA-ECLS and bail out catheter directed thrombolysis. In our experience catheter directed thrombolysis comes with an acceptable bleeding risk despite use of mechanical circulatory support, particularly with meticulous attention to vascular access and dose response monitoring.

scholarly journals Midterm Prognosis of Patients With Pulmonary Embolism Receiving Catheter‐Directed Thrombolysis or Systemic Thrombolysis: A Nationwide Population‐Based Study

2021 ◽  
Author(s):  
Donna Shu‐Han Lin ◽  
Yu‐Sheng Lin ◽  
Cho‐Kai Wu ◽  
Heng‐Hsu Lin ◽  
Jen‐Kuang Lee
Keyword(s):  
Pulmonary Embolism ◽  
Mortality Rate ◽  
Bleeding Risk ◽  
Reperfusion Therapy ◽  
Research Database ◽  
Inverse Probability ◽  
Systemic Thrombolysis ◽  
Catheter Directed Thrombolysis ◽  
All Cause Mortality

Background This study compared the efficacy and safety between catheter‐directed thrombolysis (CDT) and systemic thrombolysis for patients with acute pulmonary embolism (PE) with midterm follow‐up. Methods and Results We conducted a prospective open cohort study by using data from the Taiwan National Health Insurance Research Database for 2001 to 2013. Patients who were first admitted for PE and were treated by either systemic thrombolysis or CDT were included and compared. Inverse probability of treatment weighting, based on the propensity score, was used to mitigate possible selection bias. A total of 145 CDT‐treated and 1158 systemic thrombolysis–treated patients with PE were included. The in‐hospital mortality rate was significantly lower in the CDT group (12.7% versus 21.4%; odds ratio, 0.49; 95% CI, 0.36–0.67) after inverse probability of treatment weighting. No significant differences between the groups were observed for the safety (bleeding) outcomes. In patients who survived the index PE admission, the 1‐year all‐cause mortality rate was significantly lower in the CDT group after inverse probability of treatment weighting (12.2% versus 13.2%; hazard ratio [HR], 0.73; 95% CI, 0.56–0.94). Treatment with CDT was also associated with lower risks of recurrent PE (9.3% versus 17.5%; subdistribution HR, 0.52; 95% CI, 0.41–0.66). The difference remained through the last follow‐up. Conclusions Among patients with PE requiring reperfusion therapy, those accepting CDT had lower all‐cause mortality and recurrent PE over both short‐term and midterm follow‐up periods than those receiving systemic thrombolysis. The bleeding risk was similar for both groups. These findings should be cautiously validated in future randomized trials.

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